Why the study?
Catheter ablation for atrial tachycardia originating from the atrial appendage can be challenging and carries a risk of complications.
A minimally invasive surgical approach using direct visual unipolar electrocautery via minithoracotomy is a safe and effective alternative for atrial tachycardia originating from the right atrial appendage when percutaneous ablation is unsuccessful.
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Supports feasibility of minithoracotomy electrocautery for refractory right atrial appendage tachycardia; hypothesis-generating case report requiring prospective validation.
BACKGROUND: Catheter ablation for atrial tachycardia (AT) originating from the atrial appendage can be challenging, and it carries a risk of complications. CASE SUMMARY: A 65-year-old woman with drug-refractory AT originating from the base of a bifid right atrial appendage underwent a hybrid procedure after failed radiofrequency ablation. Via minithoracotomy, the earliest activation site was visually identified and successfully ablated under direct vision using unipolar electrocautery, resulting in immediate termination and noninducibility. The patient remained asymptomatic in sinus rhythm at the 1-month follow-up. DISCUSSION: Direct visual unipolar electrocautery via minithoracotomy is a safe and effective alternative to appendage ligation or resection for managing challenging right atrial appendage-origin AT. TAKE-HOME MESSAGES: A minimally invasive surgical approach with direct visual electrocautery is a safe and effective therapeutic alternative for challenging appendage-origin AT. This technique should be considered when percutaneous ablation is unsuccessful or high risk.
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Zang et al. (2025) studied this question.
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